Managed Care Liaison
Bronx, NY, US
Brooklyn, NY, US
NEW YORK, NY, US
This is a vital new position within the Care Coordination Program. The Managed Care Liaison reports to the Behavioral Health Operations Supervisor and are responsible for ensuring that the Medicaid Managed Care Organizations which pay for the services each child receive, are in-place, responsive to the needs of the child, and informed of key changes in the child’s life. This individual coordinates with Graham’s Care Coordinators, Billing Team, Information Technology Team, and the Foster Care Liaisons from the Medicaid Managed Care Organizations to create and sustain systems to ensure coverage and payment. The Managed Care Liaison will manage the day-to-day operations of ensuring Medicaid coverage and payment for every eligible child in foster care.
This new role at Graham requires an individual, who thrives on organizing details, is excited about systems, advocates for services, builds meaningful relationships and is an excellent problem solver. Other qualities include:
- Demonstrated ability to handle multiple tasks to completion.
- Demonstrated ability to build effective internal and external relationships.
- Demonstrated ability to understand policies and operationalize them into effective practices.
- Ability to operationalize policy and sees obstacles as an opportunity to dig deeper to find the error and drive the solution.
- Be well versed in the unique and complex needs of the foster care population and be knowledgeable of the policies and systems that guide their care.
- Establish and sustain relationships with all MMCOs with which Graham has contracts.
- Work in collaboration with the 29i Health Facility Team: Care Coordination nursing and clinical staff, OLHRS providers, MH 31 providers, Health Homes, CFTSS/HCBS providers, billing staff, etc.
- Act as the primary contact person for the MMCP to assist with MMCP enrollment, disenrollment and transitions, immediate issuance of the welcome packet, securing identification showing effective enrollment date and continuous replacement of the insurance identification card as applicable.
- Assist with foster care placement changes including access to health care and facilitating a single case agreement when a child is placed outside of the MMCP’s service area or provider network.
- Upon a child’s placement and throughout placement, help maintain eligibility for Medicaid or other public health insurance.
- Regularly review and verify child’s status in ePaces by establishing a process to routinely verify Medicaid status and maintain regular communication about coverage with Care Coordination program, parents and foster parents, case planning, other relevant program and billing staff regarding Medicaid eligibility and any changes in that status.
- Work with IT and program to create a system to track and verify health insurance eligibility and status regularly. Upon discharge, work with program staff and the child’s family to ensure the continuity of medical coverage.
- Ascertain and verify that each child is assigned a PCP and along with CC team determine if PCP needs to be changed upon the best interests of the child. Inform and coordinate with the MMCP when a child/youth’s primary care provider needs to be changed.
- Ensure appropriate notifications to MMCOs for the following: changes in placement, billing concerns, consent and confidentiality issues and court orders.
- Develop and implement a system of communication and notification with MMCP’s that includes: Mechanisms for sending and receiving information, including new enrollments or dis-enrollments from MMCP’s, Foster Care intake and discharge status, changes in placement or address, changes in health status or provider, etc.
- Responsible for coordinating with the Medicaid Managed Care Plan’s Foster Care Liaison.
- Refers children for needed services and assists in provider selection.
- Interacts with clinical and billing staff to understand and successfully resolve issues.
- Coordinates with health care providers, including school and community based services.
- Meets the highest standards for ethical and professional conduct at all times and towards all.
- Excellent written and oral communication skills
- Strong interpersonal skills and building relationships
- Experience, expertise, and knowledge of:
- The child welfare system
- Foster care health requirements
- Unique and complex needs of the foster care population
- Policies and procedures
- 29i Health Facility policies and procedures
- MMC policies and procedures
- Bachelor’s Degree Preferred. AA/AS degree in healthcare, business administration, social work, psychology, nursing, public health, or related field will be considered.
- years minimum experience in a youth/family centered medical, behavioral, or mental health/psychosocial treatment environment